Patent Foramen Ovale (PFO) Closure
Patent Foramen Ovale (PFO) closure is a medical procedure used to seal a small opening between the upper chambers of the heart (the atria) that normally closes shortly after birth. Unlike atrial septal defects, which result from improper formation of the heart wall during fetal development, a PFO is a naturally occurring opening present in all babies before birth. In some individuals, this opening does not close on its own.
While a PFO often causes no symptoms, in certain cases it may allow blood—and potentially small clots—to pass between the heart’s chambers and travel to the brain, increasing the risk of stroke. PFO closure is performed to eliminate this risk. The procedure may be done through a minimally invasive catheter-based approach or, less commonly, as open-heart surgery, depending on individual circumstances.
What does it do?
PFO itself rarely causes symptoms and is often discovered during investigations for other health concerns, particularly after an unexplained stroke. In people with PFO, there is a small flap-like opening in the atrial wall that can allow unfiltered blood to bypass the lungs and flow directly from one atrium to the other. If a clot passes through this hole, it could potentially travel to the brain and cause a stroke.
Closing this opening helps reduce the risk of future strokes by preventing abnormal blood flow and clot migration. In some cases, the condition may be managed with medications alone, but in others, closure is recommended to offer better long-term protection.
How does it work?
PFO closure involves sealing the hole that remains open between the upper heart chambers. Diagnosis is typically made through advanced heart imaging, such as a transthoracic echocardiogram (TTE) or a transoesophageal echocardiogram (TOE).
Treatment options include:
- Conservative management with blood-thinning medication to reduce clot formation
- Percutaneous closure using a catheter and a small closure device, which is the most common method
- Surgical closure, typically reserved for select cases or when other heart surgery is being performed
Treatment options include:
- Conservative management with blood-thinning medication to reduce clot formation
- Percutaneous closure using a catheter and a small closure device, which is the most common method
Surgical closure, typically reserved for select cases or when other heart surgery is being performed
Why is it performed?
In most cases, PFO does not require treatment. However, closure may be recommended if:
- You have had a stroke with no other identifiable cause
- The opening is large enough to pose a significant risk
- You have a history of recurrent strokes or embolic events
The goal is to prevent future strokes and improve long-term cardiovascular safety in selected patients.
The procedure
Your doctor will determine the most suitable approach based on your health status and risk factors:
Minimally Invasive (Percutaneous) Approach:
- Local anaesthetic is applied to the groin
- A catheter with a closure device is inserted into a leg vein
- The catheter is guided to the heart under imaging guidance
- The device is deployed to seal the flap from both sides
Surgical Approach (less common):
- Performed under general anaesthesia
- A heart-lung bypass machine may be used
- An incision is made in the chest
- The flap is directly sutured closed
- The incision is then closed and dressed
In conditions such as aortic stenosis, the valve becomes narrowed or stiffened, making it difficult for blood to flow through. This forces the heart to work harder and may eventually lead to symptoms like breathlessness, chest pain, and increased risk of heart failure. TAVI helps restore proper blood flow, relieve strain on the heart, and improve quality of life.
Recovery
After the procedure, your heart will be monitored using follow-up imaging to confirm successful closure. Your medical team will provide:
- Instructions on recovery and activity restrictions
- Guidance on any required medications (e.g. antiplatelets)
- A schedule for follow-up appointments
Most patients recover quickly, especially after the minimally invasive approach, and are able to return to normal activities within a short time.
In conditions such as aortic stenosis, the valve becomes narrowed or stiffened, making it difficult for blood to flow through. This forces the heart to work harder and may eventually lead to symptoms like breathlessness, chest pain, and increased risk of heart failure. TAVI helps restore proper blood flow, relieve strain on the heart, and improve quality of life.